Canada Doctors Reap ROI From EHRs

Medical practices and the Canadian government save millions per year after transitioning to electronic health records, study says.

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Canada, which began subsidizing electronic health records (EHRs) systems for its physicians a few years before the U.S. did, is starting to see financial benefits from the use of EHRs, according to a new report. Canada Health Infoway, the nonprofit firm that administers the government subsidy program, commissioned the EHR benefits evaluation study from PWC.

Based on a survey of Canadian and international literature and unpublished studies, the report said community-based practices saved an estimated $84 million Canadian ($82.9 million U.S.) in 2012 from the reduction in paper record handling. In addition, EHR use has decreased the numbers of duplicate tests and adverse drug events, saving $93 million ($91.8 million U.S.) last year for the government-financed healthcare system.

However, the "maturity of use" among the 56% of Canadian physicians who have EHRs is still limited, the study found. For example, only a small fraction of them are expected to benefit from using their EHRs to improve chronic disease management and preventive care.

A recent RAND study of U.S. healthcare showed that, despite the increased use of EHRs, "the quality and efficiency of patient care are only marginally better" than they were before the government launched its EHR incentive program. Another recent study found that a third of U.S. physicians were dissatisfied with the ability of EHRs to decrease their workload, and about the same percentage had not recovered their productivity since they adopted EHRs.

The Infoway report, in contrast, suggested that Canadian physicians are weathering the transition to EHRs fairly well.

Since implementing EHRs, for example, 67% of family physicians, office managers and specialists in Canadian province Saskatchewan report that their practices are more productive than they were earlier. And according to a pan-Canadian study cited by Infoway, physician office billings remained stable from the date of EHR implementation through an 18-month follow-up period.

That study did not measure the numbers of patients seen, noted Jennifer Zelmer, senior VP of clinical adoption and innovation at Canada Health Infoway, in an interview with InformationWeek Healthcare. But, like their U.S. counterparts, Canadian physicians receive most of their revenue from fee-for-service billing. So the data suggests that most doctors continued to see as many patients as they did before adopting EHRs, she said.

The report cited another Canadian study showing that primary care physicians recouped their investment in electronic medical records (EMRs) within 10 months. "Fourteen of 17 primary care clinics had a positive return on their investments in EMRs and for those, time to break-even ranged from 1-37 months."

Of course, ROI depends partly on how much a practice has invested in its EHR. Operating through the provincial governments, Infoway has so far given $340 million to nearly 20,000 physicians for EHR implementation, Zelmer said. The organization is continuing to pay more to doctors who achieve "clinical value milestones" (similar to Meaningful Use) in their use of EHRs, she added.

Some practices adopted EHRs before the subsidy programs began in different provinces, she said. So some doctors invested more in their systems than others did. The same is true in the U.S., where many physicians already had EHRs before the Meaningful Use program began.

Canadian physicians, however, may have a leg up on U.S doctors in achieving ROI. That's because Infoway has created "peer to peer clinical support networks" in which experienced EHR users help new adopters figure out how to integrate EHRs into their workflow. "That kind of approach has been really effective in helping physicians who are newer users to use some more of those advanced functions," Zelmer pointed out.

The report indicated that Canadian physicians are beginning to see the quality and safety benefits of EHRs. Most Alberta, Canada, physicians, for example, said their patients were receiving test results faster and were ordering fewer redundant tests since they got EHRs. They also stated that their ability to manage patients' chronic diseases has been improved by the use of EHR alerts and reminders.

But the report noted that only three percent to 18% of primary care physicians in Canada were estimated to be using their EHRs to improve chronic and preventive care.

"The experience has been that when physicians first adopt EHRs, there are some functions they use right away and others that they start to pick up over time," Zelmer observed. "And some physicians are still early in their EMR journey. They're still in that first sense of getting the initial use and the initial benefits."

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